SOLANO COUNTY, Calif. — A forensic pathologist who participated in the prosecution’s original neuropathology review of the death of 2½-month-old Elijah Clay testified Friday that the infant’s medical findings are extraordinarily complex and cannot, by themselves, establish abusive head trauma, as the preliminary hearing against Tre Clay continued before Judge Ellis.
Tre Clay appeared in court represented by Deputy Public Defender Jeannette Garcia. Deputy District Attorney Elaine Kuo represented the prosecution.
The defense called Dr. Evan Matshes, chief forensic pathologist and medical director for NAG Forensic, who participated in the original neuropathology review conducted at the request of the Solano County Coroner’s Office. Judge Ellis accepted Matshes as an expert in pathology and neuropathology after hearing testimony regarding his education, board certifications and experience.
The case stems from the January 2021 death of Elijah Clay. Prosecutors allege the infant died from abusive head trauma, while the defense has challenged that conclusion through multiple expert opinions, including a recent report by neurologist Dr. Roland Auer arguing that Elijah suffered from numerous underlying medical conditions rather than fatal abuse.
Matshes testified that NAG Forensic received Elijah Clay’s brain, eye, cervical spine and spinal cord specimens from the Solano County Coroner’s Office in March 2021.
The examinations were conducted by forensic neuropathologist Dr. Vivian Snyder and underwent an extensive peer-review process because of the complexity of the case. Matshes testified that he personally reviewed photographs and microscopic slides as one of several reviewers.
Summarizing the findings from that review, Matshes testified, “In short, that Elijah’s brain was very abnormal, that there was bleeding present, that was old and new, that there was brain pathology that was old and difficult to explain, that there was infection around his brain, the significance of which wasn’t known, that his spine was uninjured and that his eyes were uninjured.”
Garcia questioned Matshes about published recommendations he co-authored regarding infant autopsies.
Asked about the most important principles, Matshes testified, “At a very high level to approach unexpected infant death with an open mind, to be thorough and fact-facing, to document what you see and what you don’t see, and to make those materials available for review.”
Garcia also asked about the ophthalmology findings. Matshes testified there was no evidence of retinal hemorrhages, retinoschisis or macular folds, but cautioned that he does not regard either the presence or absence of those findings as determinative of abuse.
“I’ve written and taught heavily on this subject and consistently testify to my teachings, which is that I do not use the eye hemorrhages to diagnose abuse, nor do I use their absence to say abuse did not happen,” Matshes testified. “So from my school of thought, this is a meaningless finding.”
He also testified that the cervical spine examination showed no injuries.
“The examination that was performed on the cervical spine was thorough and complete by Dr. Snyder. It showed that the spine was not injured, which means that if one was looking for evidence of whiplash such as might occur with shaken or some forms of severe impact, the neck was not injured by such a mechanism,” Matshes testified.
When Garcia asked whether the pathology findings supported a diagnosis of abusive head trauma, Matshes said the neuropathology evidence alone was insufficient to answer that question.
“I don’t have enough information to make that conclusion because that’s well beyond the mandate I was given as a peer reviewer for the neuropathology specimens,” he testified. “We would make the conclusion of abusive head trauma or not abusive head trauma based on much more information.”
Matshes nevertheless emphasized the significance of the spinal findings, stating, “The spine in my school of thought, as I understand pediatric forensic pathology, the normalcy of that spine is of tremendous significance in my practice.”
He further testified that Elijah Clay’s brain pathology was unlike most cases he has encountered.
“And through our group, we see several hundred alleged abusive head trauma cases per year, sometimes 500 or 600 or more,” Matshes testified. “Elijah’s case stands out as an outlier in terms of the underlying complexity of his brain disease. This is a very complex neuropathology.”
Responding to questions from Judge Ellis, Matshes explained that the brain findings could have multiple explanations.
“There are features present that on one hand could be interpreted as physical injury and on the other may entirely be natural disease,” he testified. He added that “all of those possibilities remain on the table because they can’t be resolved by the brain exam.”
Matshes also cautioned against assuming bleeding necessarily indicates trauma.
“We are frequently lulled into a sense of complacency by the presence of blood around the brain because, as humans, we associate blood with trauma, but blood inside the head of a human is also the result sometimes of natural disease,” he testified. “Up to half of babies will be born with subdural hemorrhages just from the act of birth.”
Asked by Judge Ellis about alternative explanations for the pathology, Matshes testified that meningitis and bleeding disorders remained among the possibilities. He also noted that current practice would include genetic testing for bleeding disorders that may produce similar findings in infants.
Garcia asked whether the neuropathology report complicated a straightforward trauma conclusion. Although Matshes noted his group had not been asked to determine the cause of death, he testified, “I would suggest that if someone was thinking this was straightforward trauma, the neuropathology report does not confirm that.”
On cross-examination, Kuo asked Matshes whether he agreed that rapid acceleration and deceleration, commonly referred to as shaking, can cause abusive head trauma and death in infants.
“Agreed strongly,” Matshes testified.
He also reaffirmed that he had not been asked to determine the cause of death in Elijah Clay’s case and that additional information beyond the neuropathology findings would be necessary before offering an opinion on whether abusive head trauma occurred.
Friday’s testimony was notable because the defense called a physician who participated in the prosecution’s original neuropathology review rather than a retained defense expert. While Matshes did not offer an opinion on the ultimate cause of death, he repeatedly testified that the neuropathology findings alone could not resolve whether Elijah’s injuries resulted from trauma or underlying disease and described the case as one of the most medically complex infant brain cases he has reviewed.
The hearing follows the defense’s continuing effort to challenge the prosecution’s theory through medical evidence. A recent report by neurologist Dr. Roland Auer concludes that Elijah Clay’s death involved multiple underlying medical conditions, including prematurity, infection and other physiological abnormalities, and argues those conditions were overlooked in favor of an abusive head trauma diagnosis.
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